The Effect of Concomitant Hysterectomy Route on Robotic Sacrocolpopexy Outcomes.

Abstract

Importance: Sacrocolpopexy is essential in the surgical management of advanced pelvic organ prolapse, and selecting the appropriate route for concomitant hysterectomy is critical.

Objectives: The aim of this study was to evaluate the effect of the hysterectomy route at the time of robot-assisted laparoscopic sacrocolpopexy (RA-SCP) on mesh exposure. Secondary outcomes were perioperative complications and prolapse recurrence.

Study design: This was a retrospective cohort study of 405 patients who underwent an RA-SCP at our institution from January 2013 to July 2019 with at least 6 month follow-up; the patients were grouped with respect to hysterectomy route as robot-assisted supracervical hysterectomy (SCH), total vaginal hysterectomy (VH), and posthysterectomy (PH). The primary outcome measure was mesh exposure. Short-term complications and anatomic failure were also analyzed.

Results: Two hundred three of our patients (50.1%) had a concomitant SCH, 93 (23.0%) had a concomitant VH, and 109 (26.9%) were PH at the time of their robotic sacrocolpopexy. Sacrocolpopexy mesh exposure occurred in 4 patients (1%), with an additional 6 patients (1.5%) with midurethral sling mesh exposure. Mesh exposure rates did not differ significantly between groups. At 6 months after surgery, anatomic failure rates did not differ significantly between groups (P = 0.69).Intraoperative and postoperative complication rates were low (bowel obstruction, 2.0%; bladder injury, 1.2%, after excluding those caused by sling trocars; venous thromboembolism, 0.7%; transfusion, 0.5%). Postoperative infection and readmission rates did not differ significantly between groups.

Conclusions: Patients with different routes of hysterectomy at the time of RA-SCP have similar mesh exposure and prolapse recurrence rates. Serious complications are rare in all groups.